Lethal injection

Opponents in particular critique the operation of lethal injections by untrained corrections officers and the lack of guarantee that the victim will be unconscious in every individual case.

[3][4] Lethal injection gained popularity in the late 20th century as a form of execution intended to supplant electrocution, gas inhalation, hanging and firing squad, that were considered to be less humane.

[6] Bleyer's idea would not be revived until at least the mid-1970s, when Texas and Oklahoma adopted the modern version of the method; Finally, a series of botched executions led to an eventual rise of public disapproval in electrocutions in the 1980s.

[9] Royal Commission on Capital Punishment 1949–1953 also considered lethal injection, but eventually ruled it out after pressure from the British Medical Association (BMA).

"[13][12] The Chapman protocol was approved by anesthesiologist Stanley Deutsch, formerly Head of the Department of Anaesthesiology of the Oklahoma University Medical School,[8] the On August 29, 1977,[14] Texas adopted the new method of execution, switching from electrocution.

On December 7, 1982, Texas became the first U.S. state and territory in the world to use lethal injection to carry out capital punishment, for the execution of Charles Brooks, Jr.[15][16] The People's Republic of China began using this method in 1997, Guatemala in 1996, the Philippines in 1999, Thailand in 2003, and Taiwan in 2005.

[24] In the execution of Carey Dean Moore on August 14, 2018, the State of Nebraska used a novel drug cocktail comprising diazepam, fentanyl, cisatracurium, and potassium chloride,[25] over the strong objections of the German pharmaceutical company Fresenius Kabi.

[27] In August 2017, the State of Florida first used the drug in the execution of Mark James Asay using a combination of etomidate, rocuronium bromide, and potassium acetate as part of a new protocol.

[28] In the United States, the typical lethal injection begins with the condemned person being strapped onto a gurney; two intravenous cannulas ("IVs") are then inserted, one in each arm.

Following this, the warden signals that the execution may commence, and the executioner(s) (either prison staff or private citizens depending on the jurisdiction) then manually inject the three drugs in sequence.

Death usually occurs within seven minutes, although, due to complications in finding a suitable vein, the whole procedure can take up to two hours, as was the case with the execution of Christopher Newton on May 24, 2007.

[37] In 2011, after pressure by activist organizations, the manufacturers of pentobarbital and sodium thiopental halted the supply of the drugs to U.S. prisons performing lethal injections and required all resellers to do the same.

The number of shooting executions slowly decreased; and, in February 2009, the Supreme People's Court ordered the discontinuation of firing squads by the following year under the conclusion that injections were more humane to the prisoner.

Pancuronium bromide (Pavulon) is used to cause muscle paralysis and decreased neural transmission to the lungs, potassium chloride to stop the heart, and midazolam for sedation.

[46][47] At approximately 8 mEq/L and beyond, the shortened refractory period and increased resting membrane potential diminishes the quantity of voltage-gated sodium channels ready to contribute to rapid phase 0 depolarization due to the inactivation gate requiring further repolarization to open back up.

The Ohio protocol, developed after the incomplete execution of Romell Broom, aims to ensure the rapid and painless onset of anesthesia by only using sodium thiopental and eliminating the use of Pavulon and potassium as the second and third drugs, respectively.

It also provides for a secondary fail-safe measure using intramuscular injection of midazolam, followed by sufentanil or hydromorphone in the event intravenous administration of the sodium thiopental proves problematic.

Since then, numerous death-row inmates have brought such challenges in the lower courts, claiming that lethal injection as practiced violates the ban on "cruel and unusual punishment" found in the Eighth Amendment to the United States Constitution.

On April 1, 2019, The Supreme Court ruled against Bucklew on the grounds that his proposed alternative to lethal injection, nitrogen hypoxia, was neither "readily implemented" nor established to "significantly reduce a substantial risk of severe pain".

[83][84] Opponents of lethal injection have voiced concerns that abuse, misuse and even criminal conduct is possible when there is not a proper chain of command and authority for the acquisition of death-inducing drugs.

They argue that thiopental is an ultrashort-acting barbiturate that may wear off (anesthesia awareness) and lead to consciousness and an uncomfortable death wherein the inmates are unable to express discomfort because they have been paralyzed by the paralytic agent.

Given the near absence of scientific, peer-reviewed data on the topic of thiopental post mortem pharmacokinetics, the controversy continues in the lethal-injection community and, in consequence, many legal challenges to lethal injection have not used the Lancet article.

This study – published in the online journal PLOS Medicine[87] – confirmed and extended the conclusions made in the original article and goes further to disprove the assertion that the lethal-injection process is painless.

In addition, opponents point to instances where the intravenous line has failed, or when adverse reactions to drugs or unnecessary delays have happened during the process of execution.

[92] A study published in 2007 in PLOS Medicine suggested that "the conventional view of lethal injection leading to an invariably peaceful and painless death is questionable".

[93] The execution of Romell Broom was abandoned in Ohio on September 15, 2009, after prison officials failed to find a vein after two hours of trying on his arms, legs, hands, and ankle.

[98] Post mortem examinations of inmates executed by lethal injection have revealed a common finding of heavily congested lungs consistent with pulmonary edema.

[53] Thiopental is a rapid and effective drug for inducing unconsciousness, since it causes loss of consciousness upon a single circulation through the brain due to its high lipophilicity.

[106] In a California legal proceeding addressing the issue of the lethal-injection cocktail being "cruel and unusual", state authorities said that the time to death following a single injection of a barbiturate could be as much as 45 minutes.

A 2017 study found that four U.S. states that allow capital punishment are stockpiling lethal-injection drugs that are in short supply and may be needed for life-saving medical procedures elsewhere.